Chapter 28

Question 1

A highly agitated client paces the unit and states, “I could buy and sell this place.” The client’s mood fluctuates from fits of laughter to outbursts of anger. Which is the most accurate documentation of this client’s behavior?
A.
“Rates mood 8/10. Exhibiting looseness of association. Euphoric.”
B.
“Mood euthymic. Exhibiting magical thinking. Restless.”
C.
“Mood labile. Exhibiting delusions of reference. Hyperactive.”
D.
“Agitated and pacing. Exhibiting grandiosity. Mood labile.”

Answer 1

D

Question 2

A client diagnosed with bipolar disorder is distraught over insomnia experienced over the last 3 nights and a 12-pound weight loss over the past 2 weeks. Which should be this client’s priority nursing diagnosis?
A.
Knowledge deficit R/T bipolar disorder AEB concern about symptoms
B.
Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss
C.
Risk for suicide R/T powerlessness AEB insomnia and anorexia
D.
Altered sleep patterns R/T mania AEB insomnia for the past 3 nights

Answer 2

B

Question 3

A nurse is planning care for a client diagnosed with bipolar disorder: manic phase. In which order should the nurse prioritize the listed client outcomes?
Client Outcomes:
1. Maintains nutritional status.
2. Interacts appropriately with peers.
3. Remains free from injury.
4. Sleeps 6 to 8 hours a night.

A.
2, 1, 3, 4
B.
4, 1, 2, 3
C.
3, 1, 4, 2
D.
1, 4, 2, 3

Answer 3

C.

3, 1, 4, 2

Question 4

A client diagnosed with bipolar disorder: depressive phase intentionally overdoses on sertraline (Zoloft). Family reports that the client has experienced anorexia, insomnia, and recent job loss. What should be the priority nursing diagnosis for this client?
A.
Risk for suicide R/T hopelessness
B.
Anxiety: severe R/T hyperactivity
C.
Imbalanced nutrition: less than body requirements R/T refusal to eat
D.
Dysfunctional grieving R/T loss of employment

Answer 4

A

Question 5

A client diagnosed with bipolar I disorder: manic episode refuses to take lithium carbonate due to excessive weight gain. In order to increase compliance, which medication should a nurse anticipate that a physician would prescribe?
A.
Sertraline (Zoloft)
B.
Valproic acid (Depakote)
C.
Trazodone (Desyrel)
D.
Paroxetine (Paxil)

Answer 5

B

Question 6

A client diagnosed with bipolar I disorder is exhibiting severe manic behaviors. A physician prescribes lithium carbonate (Eskalith) and olanzapine (Zyprexa). The client’s spouse questions the Zyprexa order. Which is the appropriate nursing reply?
A.
“Zyprexa in combination with Eskalith cures manic symptoms.”
B.
“Zyprexa prevents extrapyramidal side effects.”
C.
“Zyprexa ensures a good night’s sleep.”
D.
“Zyprexa calms hyperactivity until the Eskalith takes effect.”

Answer 6

D

Question 7

A client began taking lithium for the treatment of bipolar disorder approximately 1 month ago. The client asks if it is normal to have gained 12 pounds in this time frame. Which is the appropriate nursing reply?
A.
“That’s strange. Weight loss is the typical pattern.”
B.
“What have you been eating? Weight gain is not usually associated with lithium.”
C.
“Weight gain is a common, but troubling, side effect.”
D.
“Weight gain only occurs during the first month of treatment with this drug.”

Answer 7

C

Question 8

A nursing instructor is teaching about the prevalence of bipolar disorder. Which student statement indicates that learning has occurred?
A.
“This disorder is more prevalent in the lower socioeconomic groups.”
B.
“This disorder is more prevalent in the higher socioeconomic groups.”
C.
“This disorder is equally prevalent in all socioeconomic groups.”
D.
“This disorder’s prevalence cannot be evaluated based on socioeconomic groups.”

Answer 8

B

Question 9

A client diagnosed with bipolar disorder, who has taken lithium carbonate (Lithane) for 1 year, presents in an emergency department with severe diarrhea, blurred vision, and tinnitus. How should the nurse interpret these symptoms?
A.
Symptoms indicate consumption of foods high in tyramine.
B.
Symptoms indicate lithium carbonate discontinuation syndrome.
C.
Symptoms indicate the development of lithium carbonate tolerance.
D.
Symptoms indicate lithium carbonate toxicity.

Answer 9

D

Question 10

What tool should a nurse use to differentiate occasional spontaneous behaviors of children from behaviors associated with bipolar disorder?
A.
“Risky Activity” tool
B.
“FIND” tool
C.
“Consensus Committee” tool
D.
“Monotherapy” tool

Answer 10

C

Question 11

A client diagnosed with bipolar disorder weighs 220 lb. A physician orders lamotrigine (Lamictal) 10 mg/kg/day to a maximum of 400 mg/day for mood stabilization. Which is a true statement about this medication order?
A.
This calculated dosage is within the recommended dosage range.
B.
This calculated dosage is lower than the recommended dosage range.
C.
This calculated dosage is more than twice the recommended dosage range.
D.
This calculated dosage is four times higher than the recommended dosage range.

Answer 11

C

Question 12

A nursing instructor is discussing various challenges in the treatment of clients diagnosed with bipolar disorder. Which student statement demonstrates an understanding of the most critical challenge in the care of these clients?
A.
“Treatment is compromised when clients can’t sleep.”
B.
“Treatment is compromised when irritability interferes with social interactions.”
C.
“Treatment is compromised when clients have no insight into their problems.”
D.
“Treatment is compromised when clients choose not to take their medications.”

Answer 12

D

Question 13

A client is diagnosed with bipolar disorder: manic phase. Which nursing intervention would be implemented to achieve the outcome of “Client will gain 2 lbs by the end of the week?”
A.
Provide client with high-calorie finger foods throughout the day.
B.
Accompany client to cafeteria to encourage adequate dietary consumption.
C.
Initiate total parenteral nutrition to meet dietary needs.
D.
Teach the importance of a varied diet to meet nutritional needs.

Answer 13

A

Question 14

A client is diagnosed with bipolar disorder and admitted to an inpatient psychiatric unit. Which is the priority outcome for this client?
A.
The client will accomplish activities of daily living independently by discharge.
B.
The client will verbalize feelings during group sessions by discharge.
C.
The client will remain safe throughout hospitalization.
D.
The client will use problem solving to cope adequately after discharge.

Answer 14

C

Question 15

A nurse begins the intake assessment of a client diagnosed with bipolar I disorder. The client shouts, “You can’t do this to me. Do you know who I am?” Which is the priority nursing action in this situation?
A.
To provide self and client with a safe environment
B.
To redirect the client to the needed assessment information
C.
To provide high-calorie finger foods to meet nutritional needs
D.
To reorient the client to person, place, time, and situation

Answer 15

A

Question 16

A client is diagnosed with cyclothymic disorder. What client behaviors should the nurse expect to assess?
A.
The client expresses “feeling blue most of the time.”
B.
The client has endured periods of elation and dysphoria lasting for more than 2 years.
C.
The client fixates on hopelessness and thoughts of suicide continually.
D.
The client has labile moods with periods of acute mania.

Answer 16

B

Question 17

After teaching a client about lithium carbonate (Lithane), which client statement would indicate to the nurse that teaching has been successful?
A.
“I should expect to feel better in a couple of days.”
B.
“I’ll call my doctor immediately if I experience any diarrhea or ringing in my ears.”
C.
“If I forget a dose, I can double the dose the next time I take this drug.”
D.
“I need to restrict my intake of any food containing salt.”

Answer 17

B

Question 18

A client has been taking lithium for several years with good symptom control. The client presents in the emergency department with blurred vision, tinnitus, and severe diarrhea. The nurse should correlate these symptoms with which lithium level?
A.
1.3 mEq/L
B.
1.7 mEq/L
C.
2.3 mEq/L
D.
3.7 mEq/L

Answer 18

B

Question 19

A newly admitted client is experiencing the manic phase of bipolar I disorder. The nurse should assign which priority nursing diagnosis to this client?
A.
Ineffective individual coping R/T hospitalization AEB alcohol abuse
B.
Altered nutrition: less than body requirements R/T mania AEB 10 lb weight loss
C.
Risk for violence: directed toward others R/T agitation and hyperactivity
D.
Sleep pattern disturbance R/T flight of ideas AEB sleeps 1 to 2 hours per night

Answer 19

C

Question 20

A client who has been diagnosed with bipolar I disorder states, “God has taught me how to decode the Bible.” A nurse should anticipate that which combination of medications would be ordered to address this client’s symptoms?
A.
Lithium carbonate (Lithobid) and risperidone (Risperdal)
B.
Lithium carbonate (Lithobid) and carbamazepine (Tegretol)
C.
Valproic acid (Depakote) and sertraline (Zoloft)
D.
Valproic acid (Depakote) and lamotrigine (Lamictal)

Answer 20

A

Question 21

A nurse learns at report that a newly admitted client experiencing mania is demonstrating grandiose delusions. The nurse should recognize that which client statement would provide supportive evidence of this symptom?
A.
“I can’t stop my sexual urges. They have led me to numerous affairs.”
B.
“I’m the world’s most perceptive attorney.”
C.
“My wife is distraught about my overspending.”
D.
“The FBI has tapped my room and are out to get me.”

Answer 21

B

Question 22

Which client statement would the nurse recognize as indicating that the client understands dietary teaching related to lithium carbonate (Lithobid) treatment?
A.
“I will limit my intake of fluids daily.”
B.
“I will maintain normal salt intake.”
C.
“I will take Lithobid on an empty stomach.”
D.
“I will increase my caloric intake to prevent weight loss.”

Answer 22

B

Question 23

A client on an inpatient unit is diagnosed with bipolar disorder: manic phase. During a discussion in the dayroom about weekend activities, the client raises voice, becomes irritable, and insists that plans change. What should be the nurse’s initial intervention?
A.
Ask the group to take a vote on alternative weekend events.
B.
Remind the client to quiet down or leave the dayroom.
C.
Assist the client to move to a calmer location.
D.
Discuss with the client impulse control problems.

Answer 23

C

Question 24

A client diagnosed with bipolar disorder states, “I hate oatmeal. Let’s get everybody together to do exercises. I’m thirsty and I’m burning up. Get out of my way; I have to see that guy.” What should be the priority nursing action?
A.
Assess the client’s vital signs.
B.
Offer to have the dietitian discuss food preferences.
C.
Encourage the client to lead the exercise program in the community meeting.
D.
Acknowledge the client briefly and then walk away.

Answer 24

A

Question 25

A newly admitted client is diagnosed with bipolar disorder: manic episode. Which symptom related to altered thought is the nurse most likely to assess?
A.
Pacing
B.
Flight of ideas
C.
Liability of mood
D.
Irritability

Answer 25

B

Question 26

The inpatient psychiatric unit is being redecorated. At a unit meeting, staff discuss bedroom décor for clients experiencing mania. The nurse manager evaluates which suggestion as most appropriate?
A.
Rooms should contain extra-large windows with views of the street.
B.
Rooms should contain brightly colored walls with printed drapes.
C.
Rooms should be painted deep colors and located close to the nurse’s station.
D.
Rooms should be painted with neutral colors and contain pale-colored accessories.

Answer 26

D

Question 27

A client’s spouse asks, “What evidence supports the possibility of genetic transmission of bipolar disorder?” Which is the best nursing reply?
A.
“Clients diagnosed with bipolar disorders have alterations in neurochemicals which affect behaviors.”
B.
“Higher rates of relatives diagnosed with bipolar disorder are found in families of client’s diagnosed with this disorder.”
C.
“Higher rates of relatives of clients diagnosed with bipolar disorder respond in an exaggerated way to daily stress.”
D.
“More individuals diagnosed with bipolar disorder come from higher socioeconomic and educational backgrounds.”

Answer 27

B

Question 28

A client is admitted in the manic phase of bipolar affective disorder. Which nursing intervention should be most therapeutic for this client?
A.
Using a calm, unemotional approach during client interactions
B.
Focusing primarily on enforcing limits
C.
Limiting interactions to decrease external stimuli
D.
Encouraging the client to establish social relationships with peers

Answer 28

A